Healthcare Provider Details

I. General information

NPI: 1205556081
Provider Name (Legal Business Name): BRAL INTERNATIONAL MEDICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FLAMINGO RD STE 19
LAS VEGAS NV
89119-5244
US

IV. Provider business mailing address

1601 E FLAMINGO RD STE 18
LAS VEGAS NV
89119-5244
US

V. Phone/Fax

Practice location:
  • Phone: 702-478-9971
  • Fax: 702-478-9968
Mailing address:
  • Phone: 702-478-9971
  • Fax: 702-478-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LUIS RODRIGUEZ BAUZA
Title or Position: OWNER
Credential:
Phone: 702-478-9971